Blincoe et al. (2015)

MODELING THE ECONOMIC COST OF NON-FATAL INJURIES FROM TERRORIST ATTACKS
Nathaniel (Nat) Heatwole, Ph.D.
Center for Risk and Economic Analysis of Terrorism Events (CREATE) – University of Southern California (USC)
TABLE 1: Six levels of the Abbreviated Injury Scale (AIS)
Injury Severity
QUESTION: What are the economic costs associated with nonfatal injuries resulting from terrorism?
Process:
1. Devise methods of assessing the severity of injury.
2. Obtain injury cost data from the literature.
3. Apply metrics from #1 and costs from #2 to injuries from
terrorist attacks.
II. MEASURES OF INJURY SEVERITY
Hospitalized Injuries (HI) vs. Non-Hospitalized Injuries (NHI)
• Pros: easy to assess, data widely available
• Cons: only two levels of injury severity
Length of Stay in Hospital (LOS)
• Pros: considers degree (duration) of hospital stay
• Cons: applies only to hospitalized injuries
Abbreviated Injury Scale (AIS) – Table 1
• Note: for multiple injuries, MAIS = maximum AIS injury
• Pros: widely used, good balance of usability/clinical rigor
• Cons: AIS ratings somewhat subjective
Injury Severity Score (ISS)
• Definition: sum of squares of 3 highest AIS, each in a different
body region (6 body regions in total) (Baker et al. 1974)
• Notes: range of 1–75 (44 possible values)
• Pros: better predictor of mortality than MAIS
• Cons: more difficult to assess than AIS
III. INJURY COST DATA
All injury cost data used is summarized in Tables 2, 3, and 4.
Cost per Hospital Day
• Hospitalized injury cost (2010): $99,000 (CDC 2010 – Table 3)
• Average LOS (2010) = 4.8 days (NHDS 2010)
• Therefore: $21,000/day
• Assume: per diem cost does not vary with LOS
RESEARCH POSTER PRESENTATION DESIGN © 2015
www.PosterPresentations.com
Example Injuries
P(death)
Abrasion; laceration;
AIS 1 Minor
0.0067
strain/sprain; contusion
Simple broken bone; serious
AIS 2 Moderate
0.0075
strain/sprain
Complicated fracture; minor
AIS 3 Serious
0.035
crush injury
Massive organ injury; heart
AIS 4 Severe
0.15
laceration; loss of limb
Spinal cord syndrome; massive
AIS 5 Critical
0.40
head injury
Decapitation; partial thickness
AIS 6 Maximum
0.79
burns to >90% of body
Sources: AIS – AAAM (2008); example injuries – Willis &
LaTourrette (2008), Russell et al. (2004);
P(death), probability of death – Gennarelli & Wodzin (2006)
TABLE 2: Sources of Injury Cost Data
Cost
Severity
Source
Notes
Metric Metric(s)
CDC (2010)
COI
NHI/HI All U.S. injuries, 2010
Per diem
($/day) x (LOS) – see
COI
HI/LOS
hospital cost
Section 3
Finkelstein et al.
NHI/HI
COI
All U.S. injuries, 2000
(2006)
MAIS
Blincoe et al.
All U.S. motor vehicle
COI
MAIS
(2015)
injuries, 2010
Graham et al.
Based on assessment of
QOL
MAIS
(1997)
disability/impairment
QOL/
Quality adjusted portion of
DOT (2015)
MAIS
WTP
life lost; wage-risk VSLa
Viscusi & Aldy
WTP
none
From wage-risk studiesa
(2003)
Willis & LaTourApplies Viscusi & Aldy
WTP
MAIS
ette (2008)
injury costs to MAIS
COI = cost-of-injury (medical treatment + lost work);
QOL = quality-of-life (more intangible costs of injury);
WTP = willingness-to-pay (true value of injury risk reductions);
VSL = value of a statistical life
a Wage-risk studies examine wages and risk of on-the-job injury.
TABLE 3: Injury Cost Data – Hospitalized / Non-Hosp. (2015$)
Source
Non-Hosp.
Injuries
Hospitalized
Injuries
FIGURE 1: Mapping ISS values onto the MAIS
Fatalities
Finkelstein et al.
$4,900
$68,000
$1.3 M
(2006)
CDC (2010)
$6,400
$99,000
$1.1 M
Viscusi & Aldy
$28,000–
$28,000–
n/a
a
a
a
(2003)
$97,000
$97,000
Per diem hospital
($21,000/
n/a
n/a
cost (Section 3)
day) x (LOS)
a Does not segregate injuries values by hospitalization status.
IV. ILLUSTRATIVE EXAMPLES
6
Table 5 summarizes the injury costs for three terrorism injury
studies, indicating that the value of injury varies considerably,
both between and within studies.
5
MAIS
I. INTRODUCTION / ABSTRACT
4
Low
3
High
2
1
0
TABLE 4: Injury Cost Data – MAIS (2015$)
FinkelBlincoe et
stein et al.
al. (2015)
(2006)
Willis &
Graham
LaTourDOT
et al.
a
ette
(2015)
a,b
(1997)
(2008)a
$0c $28,000
$0c
$96,600 $440,000
$1.0 M
$96,600 $990,000
$1.5 M
$96,600
$2.5 M $660,000
$96,600
$5.6 M
$7.6 M
MAIS 1
$4,600 $12,000
MAIS 2
$13,000 $53,000
MAIS 3
$42,000 $180,000
MAIS 4 $100,000 $410,000
MAIS 5 $200,000
$1.1 M
MAIS 6
$1.3 M
$1.5 M $9.4 M
$9.4 M
$9.4 M
(fatal)
a Using a value of a statistical life of $9.4 million (DOT 2015).
b Values non-monotonic in the MAIS because of the large
proportion of MAIS 4 injuries that are non-persistent.
c These authors assume MAIS 1 injuries have zero cost.
ISS-based Injury Values
• Many terrorism injury studies assess injury severity using ISS
• No ISS injury values in the literature
• ISS based on AIS, so AIS can be mapped onto ISS (Figure 1)
• At each MAIS, plausible ISS values bounded between:
• Low: (MAIS)2 – AIS triplet (MAIS, 0, 0)
• High: 3 x (MAIS)2 – AIS triplet (MAIS, MAIS, MAIS)
• For example:
• ISS = 3  MAIS 1
• ISS = 12  MAIS 2 or MAIS 3
• ISS = 25  MAIS 3, MAIS 4, or MAIS 5
5 10 15 20 25 30 35 40 45 50 55 60 65 70 75
ISS
TABLE 5: Illustrative Examples of Terrorism Injury Costs
(2015$ per injured victim)
1980 Bologna
1989
2000-2004,
train station
Marine
various
Injury
Injury Costing
bombing
Barracks
attacks,
Severity
Method
(Brismar &
bombing
Israel
Metric
Bergenwald (Frykberg et (Sheffy et
1982)
al. 1989)
al. 2006)
Viscusi &
$28,000–
$28,000–
$28,000–
n/a
Aldy (2003)
$97,000
$97,000
$97,000
CDC (2010)
NHI/HI
$87,000
$75,000
$38,000
Hospital costa HI/LOSa
$200,000a
n/a
$280,000a
NHI/HI
$60,000
$52,000
$26,000
Finkelstein et
MAISb
$27,000a
$27,000a
$49,000a
al. (2006)
ISSc
$13,000a
$28,000a
$28,000a
Blincoe et al. MAISb
$120,000a
$110,000a $230,000a
(2015)
ISSc
$53,000a
$120,000a $120,000a
Willis &
MAISb
$90,000a
$82,000a
$84,000a
LaTour. (2008) ISSc
$97,000a
$97,000a
$97,000a
MAISb
$740,000a
$690,000a
$1.3 Ma
DOT (2015)
ISSc
$440,000a
$720,000a $720,000a
Graham et al. MAISb
$1.2 Ma
$960,000a
$1.5 Ma
(1997)
ISSc
$1.0 Ma
$1.3 Ma
$1.3 Ma
a Hospitalized victims only.
b Determined using distribution of MAIS values.
c Determined by mapping mean ISS value onto MAIS (Figure 1)
REFERENCES
(AAAM) Association for the Advancement of Automotive Medicine (2008). The Abbreviated Injury Scale 2005,
Update 2008.
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the Effects and Injuries Sustained.” J Trauma, 22(3), 216-220.
(CDC) U.S. Centers for Disease Control and Prevention (2010). WISQARS. http://www.cdc.gov/injury/wisqars/
(DOT) U.S. Department of Transportation (2015). Guidance on Treatment of the Economic Value of a Statistical
Life (VSL) in U.S. Departmental of Transportation Analyses.
Finkelstein EA, et al. (2006). The Incidence and Economic Burden of Injuries in the United States. Oxford Univ. P.
Frykberg ER, et al. (1989). “The 1983 Beirut Airport Terrorist Bombing: Injury Patterns and Implications for
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Gennarelli TA, and E Wodzin (2006). “AIS 2005: A contemporary injury scale.” Injury, 37, 1083-1091.
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(NHDS) National Hospital Discharge Survey (2010). http://www.cdc.gov/nchs/.
Russell R, et al. (2004). “Differences in Mortality Predictions Between Injury Severity Score Triplets: A
Significant Flaw.” J Trauma, 56, 1321-1324.
Sheffy N, et al. (2006). “Terror-Related Injuries: A Comparison of Gunshot Wounds Versus Secondary
Fragments-Induced Injuries from Explosives.” J American College of Surgeons, 203, 297-303.
Viscusi WK, and JE Aldy (2003). “The Value of a Statistical Life: A Critical Review of Market Estimates
Throughout the World.” J Risk and Uncertainty, 27(1), 5-76.
Willis HH, and T LaTourette (2008). “Using Probabilistic Terrorism Risk Modeling for Regulatory Benefit-Cost
Analysis: Application to the Western Hemisphere Travel Initiative in the Land Environment.” Risk
Analysis, 28(2), 325-339.
Acknowledgements: funding support from CREATE; valuable
input from Lisa Robinson and Adam Rose
AUTHOR BIO
• Ph.D. – Engineering & Public Policy, Carnegie Mellon Univ., 2011
• Dissertation topic: cost-effectiveness of protecting buildings
from vehicle bomb attacks
• B.A. – Physics, Political
Science (double major),
Guilford College, 2006
• Post-Doctoral Research
Associate, CREATE, 2011-2015
• Currently: job hunting
• E-mail:
[email protected]

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